Talk about hammering home a point: just after publication of one study that says putting physical therapists (PTs) in hospital emergency departments (EDs) leads to better overall results comes another, unrelated research effort that pinpoints an example: namely, the effect PTs in the ED has on lowering the odds for an ED revisit for patients whose initial visit was fall-related. According to authors of the new study, consultation by a PT in the ED reduced the odds of a fall-related revisit within 30 days by 35% and within 60 days by 32%, compared with patients treated in EDs with no PT consultation.

The study, published in Journal of the American Geriatrics Society, is based on Medicare claims data for individuals 65 and older who visited an ED for treatment related to a ground-level fall between 2012 and 2013. Researchers divided the claims data into 2 groups: individuals who received PT services during the ED visit (N=17,975) and a control group that didn't (N=542,302). Then, they tracked the rates of ED revisits for fall-related injury within 30 and 60 days of the initial visit. The data they examined also included injury severity (initial visit) as expressed in the New Injury Severity Score (NISS) as well as the presence of various comorbidities as identified in Medicare's Comorbidity Conditions Warehouse (CCW).

While all-cause revisits were only slightly higher for the non-PT group at 30 days (21.7% for the non-PT group compared with 20.4% for the PT group) and just about the same at 60 days (about 30% for both), researchers found more striking differences when it came to revisits related to a fall. At 30 days, 1.7% of the PT group had revisited the ED for a fall, compared with 2.6% of the non-PT group; at 60 days, the rate was 2.6% for the PT group, compared with 3.6% of the non-PT group.

There were some differences between the PT and non-PT groups. Individuals in the PT group tended to be slightly older than the non-PT group (average age of 82.4 compared with 80.6), and NISS ratings tended to be lower (less severe injury) among the PT group. Researchers explored the possibility that the lower NISS figures may have played a role in the revisit data, but when they compared individuals with an NISS of 0 (no injury noted) from both groups, they found revisit rates similar to the groups as a whole.

Other factors, however, were related to greater chances of an ED revisit. Being male, Medicaid-eligible, and having a comorbidity raised the odds of a revisit; age, however, did not. Of the comorbidities most strongly linked to increased odds of revisit, Alzheimer's disease was associated with the strongest impact.

Authors acknowledge that a PT consult in the ED may not always be appropriate, either due to the severity of injuries sustained or the intensity and prevalence of comorbidities such as dementia. Still, they argue, the consultation rates fall far short of where they should be, given the data they uncovered.

"Our results suggest that EDs could play an important role in reducing fall-related ED revisits by linking individuals who have fallen with appropriate follow-up care, yet data suggest the likelihood of receiving a PT referral from the ED after a visit for a fall is rare," authors write. "Only 3.2% of older adults presenting for a fall-related ED visit received PT services during that visit, according to claims data."

Further, authors point out, their study only tracked whether the individual received PT services during the initial ED visit—it didn't include data on whether the patients participated in any rehabilitation or falls prevention interventions after the visit, possibly "the most likely pathway through which reduction in future falls would be achieved."

APTA is a strong supporter of the importance of PTs in the ED. A House of Delegates position promotes physical therapy as a professional service in the emergency care environment, and the association offers a webpage on the topic that includes an online toolkit, a video, and links to resources from the US Department of Health and Human Services.

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

Comments

I think this is an incredible idea. I’ve worked as a PTA in a SNF for nearly 20 years and over 50% of our patients are from fall related injuries. I know most of my patients wouldn’t be able to or want to take the time to go to a PT visit. A possible thought would be to have them agree to at least one home PT visit. That way the PT could evaluate the patients home, give them suggestions for home safety, perform a fall risk safety checklist and create a home exercise program that the patient might be willing to partake in.

Posted by Brenda Holman
on 9/1/2018 11:46 AM

I have done 4 evals in the emergency department the past month all related to falls. I think having a PT evaluation saves a readmission, educates the caregiver(s) and patient, can perform standardized balance assessment(s), and then assist physicians/ARNP/LSW in making appropriate recommendations i.e. SNF vs home health PT for ;home safety evaluation vs HH PT. We are seeing more and will continue to see more evaluations from the ED.